Dialysis Is on the Ballot Again in California

Two years after California voters soundly defeated a measure that would have capped profits for dialysis centers, the people get to weigh in on a different proposal—one that would require a doctor to be on site whenever the clinic is open.

The measure, known as Proposition 23, would also require dialysis centers to report infection data to the state and not just the federal government. Clinics would need permission to close or reduce hours of operation. Finally, the measure would bar centers from refusing to treat patients based on “payment source.”

Supporters, including a service union, say it will lead to better care. Opponents include the American Nurses Association and the California Medical Association, who argue that adding six figures in costs to each dialysis center may force many to close and send dialysis patients to the emergency department if they can’t get access to care.

About 80,000 people in the state rely on dialysis treatments, which filter out waste from the blood for people with failing kidneys. Two companies, Davita and Fresenius, dominate the California dialysis market.

The ballot measure comes as the Trump administration pursues payment reforms that would make it easier for patients to have dialysis at home, by creating financial incentives that promote home dialysis technology. CMS was heading in this direction already, but the coronavirus disease 2019 (COVID-19) pandemic made home dialysis a more urgent priority, as patients with renal failure are at much higher risk of death if they develop the disease.

For-profit dialysis centers have spent heavily to defeat the measure, and were closing in on $100 in spending by mid-September, according to published reports.